The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.
The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.
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NCI 综合癌症护理的效果集中在患有癌症的青少年和年轻人 (AYA) 的结果差异上。
DOI：
10.1200/jco.2012.30.34_suppl.217
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
S. Bhatia
中科院分区：
文献类型：
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作者：
Can‐lan Sun;Heeyoung Kim;Tongjun Kang;S. Bhatia
217背景：患有癌症的AYA（诊断时15- 39岁）没有看到具有类似诊断的年轻和老年组所证明的生存改善，留下了AYA差距。虽然儿科方案治疗与15- 21岁的上级生存率相关，但诊断时22- 39岁的脆弱AYA亚群（人种/种族）的治疗部位对生存率的影响尚未研究。
方法
利用1998年至2008年期间向洛杉矶县癌症登记处报告的10，602名22- 39岁新诊断为淋巴瘤、白血病、脑肿瘤、黑色素瘤、甲状腺和GU癌症的AYA队列，我们旨在确定在NCI综合癌症中心（NCICCC）接受治疗对AYA总生存率的影响，以及种族/民族生存率的差异。我们进一步旨在了解SES和保险状况在NCICCC获得护理方面的作用。多变量分析包括人种/种族、诊断时的年龄、SES、保险状况、原发性癌症诊断和模型中的诊断年份。
结果
共有904例（9%）患者在洛杉矶县的3个NCICCC（City of Hope、Jonsson癌症中心和Norris癌症中心）接受治疗。非NCICCC治疗患者（81%）的10年总生存率（10年OS）显著低于NCICCC治疗患者（83%，p=0.02）。此外，非洲裔美国人（AA）的10年OS（68%）比非西班牙裔白人（86%，p<0.0001）更差。调整SES、保险状况、诊断和诊断年份的多变量分析显示，AA（HR=1.5，p=0.0001）的死亡风险增加。在NCICCC接受治疗的患者中，消除了因种族导致的死亡风险差异（HR=0.9，p=0.84）。然而，在非NCICCC治疗的患者中，这些结局差异持续存在（HR=1.48，p<0.0001）。独立于SES、保险和肿瘤因素，AA（OR=0.44，p<0.001）不太可能使用NCICCC。
结论
基于人群的数据显示，在NCICCC接受护理可消除AA癌症患者中观察到的不良结局。AA不太可能使用NCICCC进行治疗。目前正在探讨在NCICCC获得护理的障碍。
217 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21y, impact of site of care on survival for vulnerable AYA subpopulations (race/ethnicity) between 22-39y at diagnosis remains unstudied.
METHODS
Utilizing a cohort of 10,602 AYAs newly diagnosed between 22-39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the Los Angeles County cancer registry between 1998 and 2008, we aimed to determine the impact of receiving care at NCI Comprehensive Cancer Centers (NCICCC) on overall survival for AYAs, and disparities in survival by race/ethnicity. We further aimed to understand the role of SES and insurance status in accessing care at NCICCC. Multivariable analyses included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model.
RESULTS
A total of 904 (9%) patients received treatment at the 3 NCICCC (City of Hope, Jonsson Cancer Center, and Norris Cancer Center) in LA County. Ten-year overall survival (10y OS) was significantly worse for patients treated at non-NCICCC (81%) when compared with those treated at NCICCC (83%, p=0.02). Also, 10y OS was worse for African Americans (AA) (68%) vs. non-Hispanic whites (86%, p<0.0001). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that AA (HR=1.5, p=0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (HR=0.9, p=0.84) was abrogated. However, among patients treated at non-NCICCC, these differences in outcome persisted (HR=1.48, p<0.0001). Independent of SES, insurance and tumor factors, AA (OR=0.44, p<0.001) were less likely to use NCICCC.
CONCLUSIONS
Population-based data reveal that receipt of care at an NCICCC abrogates the inferior outcome observed among AA with cancer. AA are less likely to use NCICCC for treatment. Barriers to accessing care at NCICCC are currently being explored.